systemic disease and the mouth

Question 1

Name 3 congenital conditions and infections with dental manifestations in children

Answer 1

Syphilis - can cause changes to incisors eg - Hutchison’s incisors have bulbous crowns
TORCH infections
Ectodermal dysplasia

Question 2

Name 3 illnesses and metabolic disorders with dental manifestations in children

Answer 2

Severe childhood illness
Cancer treatments
Porphyria - change in amounts of haem and its products in the blood can be incorporated into tissues as they form - causes tooth discolouration

Question 3

What pigments from subatsnaces in the blood can cause tooth discolouration and which colour?

Answer 3

Bilirubin - green
Tetracycline - brown/grey

Question 4

What is ectodermal dysplasia?

Answer 4

A group of genetic disorders causing abnormalities in structures derived form the ectoderm including skin, hair, nails, teeth and sweat glands

Question 5

How may perinatal illness affect teeth?

Answer 5

Can cause changes to laying down and calcification of tooth tissue according to the time the illness took place
Will affect different teeth at different stages of development

Question 6

What are 6 common oral mucosal effects from systemic diseases?

Answer 6

Giant cell granuloma
OFG
RAS
Dermatoses eg - lichen planus and vesiculobullous conditions
Immune deficiency/disease
Drug relations

Question 7

What are giant cell lesions?

Answer 7

Osteoclast related lesions which may be due to local irritation which produces multinucleated giant cells in order to try and remove a pathogen

Question 8

In which 3 conditions are giant cell lesions common?

Answer 8

Renal failure
Hypoglycaemia
Parathyroid tumour

Question 9

What should you do if a pt has a giant cell lesion?

Answer 9

Check parathyroid function - can be a result of excess parathyroid stimulation of osteoclasts

Question 10

How may hyperparathyroidism manifest dentally?

Answer 10

Loss of lamina dura - will return once parathyroid is corrected

Question 11

Which 2 conditions will you find raised ACTH and how may this manifest dentally?

Answer 11

Addison’s and Cushing’s disease
Causes pigmentation, producing reactive melanosis of the oral mucosa
If widespread pigmentation, refer to GP

Question 12

Give 3 examples of immune conditions with dental manifestations?

Answer 12

OFG
Sjögren’s
Addison’s and Cushing’s

Question 13

Give 2 examples of skin immune diseases with dental manifestations

Answer 13

Lichen planus
Vesiculobullous diseases

Question 14

What are the dental manifestations of haematinic deficiencies?

Answer 14

Oral ulceration and painful tongue
Aphthous ulceration will be enhanced if low iron due to internal bleeding into gut, poor diet or malabsorption

Question 15

Name 4 signs of OFG

Answer 15

Peri-oral erythema and swelling
Lip swelling
Angular cheilitis
Proliferative, erythematous, full thickness gingiva

Question 16

Give 4 examples of autoimmune connective tissue diseases

Answer 16

Systemic lupus erythematosus (SLE)
Systemic sclerosis (scleroderma)
Sjögren’s’ syndrome
Mixed connective tissue disease (MCTD)

Question 17

How does lupus present?

Answer 17

Similar to lichen planus histologically and clinically
Desquamative gingivitis appearance
Difference found by immunology assays of the blood

Question 18

How does systemic sclerosis present and what should be done dentally?

Answer 18

Abnormal growth leads to fibrosis (hardening) of the skin and internal organs
Can make dentistry very difficult - plan years before condition progresses with restorative consultant

Question 19

Give examples of vasculitic connective tissue diseases

Answer 19

Large vessel disease:
- Giant cell (temporal) arteritis
Medium vessel disease:
- Polyarteritis nodosa
- Kawasaki disease
Small vessel disease:
Wegener’s Granulomatosis - most likely to have oral manifestations

Question 20

What is the cause of congenital immune deficiency

Answer 20

Due to failure of T cell or B cell development

Question 21

What 4 can relate to acquired immune deficiency?

Answer 21

Diabetes
Drug therapy
Cancer therapy
HIV (viruses)

Question 22

What is immune deficiency most associated with and give an example of this?

Answer 22

Oral opportunistic infections eg - Sjögren’s syndrome causing dry mouth which then leads to a candidal infection

Question 23

What is hairy leukoplakia on the lateral border of the tongue an uncommon manifestation of?

Answer 23

HIV

Question 24

Give 4 reasons for haematinic deficiencies

Answer 24

Poor intake
Malabsorption due to GI diseases - Coeliac, Crohn’s
Blood loss - Crohn’s, ulcerative colitis
Increased demand - child growth spurts

Question 25

Name 5 oral effects of medical therapy

Answer 25

Dry mouth
Oral ulceration
Lichenoid reaction
Angio-oedema eg - ACE inhibitors
Osteonecrosis - bisphosphonates

Question 26

What is angio-oedema?

Answer 26

Rapid swelling of the face
Often due to poor regulation of the complement cascade caused by inhibition of the controlling enzymes as a side effect of ACE inhibitor use
Clinical appearance similar to OFG however, will often subside within an hour and be gone within 24 hours